Nausea and vomiting are serious side effects of cancer therapy.

Nausea is an unpleasant feeling in the back of the throat and/or stomach that may come and go in waves. It may occur before vomiting. Vomiting is throwing up the contents of the stomach through the mouth. Retching is the
movement of the stomach and esophagus without vomiting and is also called dry
heaves. Although treatments for nausea and vomiting have improved, nausea and vomiting are still serious side effects of cancer therapy because they cause the patient distress and may cause other health problems. Patients may have nausea more than vomiting.

Nausea is
controlled by a part of the autonomic nervous system which controls involuntary body
functions (such as breathing or digestion). Vomiting is a reflex controlled in part by a vomiting center in the brain.
Vomiting can be triggered by smell, taste, anxiety,
pain, motion, or changes in the body caused by inflammation, poor blood flow, or irritation to the stomach.

It is important that nausea and vomiting are controlled so that the patient can continue treatment and have a better quality of life.

It is very important to prevent and control nausea and vomiting in patients with cancer, so that they can continue treatment and perform activities of daily life. Nausea and vomiting that are not controlled can cause the following:

Different types of nausea and vomiting are caused by chemotherapy, radiation therapy, and other conditions.

Nausea and vomiting can occur before, during, or after treatment.

The types of nausea and vomiting include:

Acute: Nausea and vomiting that happen within 24 hours after treatment starts.

Delayed: Nausea and vomiting that happen more than 24 hours after chemotherapy. This is also called late nausea and vomiting.

Anticipatory: Nausea and vomiting that happen before a chemotherapy treatment begins. If a patient has had nausea and vomiting after an earlier chemotherapy session, he or she may have anticipatory nausea and vomiting before the next treatment. This usually begins after the third or fourth treatment. The smells, sights, and sounds of the treatment room may remind the patient of previous times and may trigger nausea and vomiting before the chemotherapy session has even begun.

Breakthrough: Nausea and vomiting that happen within 5 days after getting antinausea treatment. Different drugs or doses are needed to prevent more nausea and vomiting.

Anticipatory Nausea and Vomiting

Key Points

Anticipatory nausea and vomiting may occur after several chemotherapy treatments.

The earlier that anticipatory nausea and vomiting is identified, the more effective treatment may be.

Anticipatory nausea and vomiting may occur after several chemotherapy treatments.

In some patients, after they have had several courses of
treatment, nausea and vomiting may occur before a treatment session. This is called anticipatory nausea and vomiting. It is caused by triggers, such as odors in the therapy room. For example, a person who begins chemotherapy and smells an alcohol swab at the same time may later have
nausea and vomiting at the smell of an alcohol swab. The more chemotherapy sessions a patient has, the more likely it is that anticipatory nausea and vomiting will occur.

Having three or more of the following may make anticipatory nausea and vomiting more likely:

Having nausea and vomiting, or feeling warm or hot after the last chemotherapy session.

Patients who have acute nausea and vomiting with chemotherapy are more likely to have delayed nausea and vomiting as well.

Acute and delayed nausea and vomiting with chemotherapy or radiation therapy are usually treated with drugs.

Drugs may be given before each treatment, to prevent nausea and vomiting. After chemotherapy, drugs may be given to prevent delayed vomiting. Patients who are given chemotherapy several days in a row may need treatment for both acute and delayed nausea and vomiting. Some
drugs last only a short time in the body and need to be given more often. Others last a long time and are given less often.

The following table shows drugs that are commonly used to prevent nausea and
vomiting caused by chemotherapy and the type of drug.

It is not known whether it is best to give antinausea medicine for the first 5 days of radiation treatment or for the full treatment course. Talk with your doctor about the treatment plan that is best for you.

Treating Nausea and Vomiting Without Drugs

Key Points

Treatment without drugs is sometimes used to control nausea and vomiting.

Treatment without drugs is sometimes used to control nausea and vomiting.

Non-drug treatments may help relieve nausea and vomiting, and may
help antinausea drugs work better. These treatments include:

Treatment-Related Nausea and Vomiting in Children

Key Points

Nausea and vomiting in children treated with chemotherapy is a serious problem.

Anticipatory nausea and vomiting may occur in children.

In children, acute nausea and vomiting is usually treated with drugs and other methods.

Delayed nausea may be hard to detect in children.

Nausea and vomiting in children treated with chemotherapy is a serious problem.

Like adults, nausea in children receiving chemotherapy is more of a problem than vomiting. Children may have anticipatory, acute, and/or delayed nausea and vomiting.

Anticipatory nausea and vomiting may occur in children.

Children who have nausea and vomiting after a chemotherapy treatment may have the same symptoms before their next treatment when the child sees, smells, or hears sounds from the treatment room. This is called anticipatory nausea and vomiting.

When the child’s nausea and vomiting is well controlled during and after a chemotherapy treatment, the child may have less anxiety before the next treatment and less chance of having anticipatory symptoms.

Health professionals caring for children who have anticipatory nausea and vomiting have found that children may benefit from:

Drugs used to treat anxiety in doses adjusted for the age and needs of the child.

In children, acute nausea and vomiting is usually treated with drugs and other methods.

Drugs may be given before each treatment to prevent nausea and vomiting. After chemotherapy, drugs may be given to prevent delayed vomiting. Patients who are given chemotherapy several days in a row may need treatment for both acute and delayed nausea and vomiting. Some drugs last only a short time in the body and need to be given more often. Others last a long time and are given less often.

The following table shows drugs that are commonly used to prevent nausea and vomiting caused by chemotherapy and the type of drug. Different types of drugs may be given together to treat acute and delayed nausea and vomiting.

Delayed nausea may be hard to detect in children.

Unlike in adults, delayed nausea and vomiting in children may be harder for parents and caregivers to see. A change in the child’s eating pattern may be the only sign of a problem. In addition, most chemotherapy treatments for children are scheduled over several days. This makes the timing and risk of delayed nausea unclear.

Studies on the prevention of delayed nausea and vomiting in children are limited. Children are usually treated the same way as adults, with doses of drugs that prevent nausea adjusted for age.

About This PDQ Summary

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This PDQ cancer information summary has current information about the causes and treatment of nausea and vomiting (emesis) (N&V). It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

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Updated: September
21, 2018

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